NPI Code Detail JSON Logo

1184841553 NPI number — TINA JEO O.D.

NPI Number: 1184841553
Health Care Provider/Practitioner: TINA JEO O.D.

Information about “1184841553” NPI (TINA JEO O.D.) exists in 1184841553 in HTML format HTML  |  1184841553 in plain Text format TXT  |  1184841553 in PDF (Portable Document Format) PDF  |  1184841553 in an XML format XML  formats.

NPI Number : 1184841553 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184841553",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JEO",
    "FirstName": "TINA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JOE",
    "OtherFirstName": "TINA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "O.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10042 NE MASON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTLAND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97220-3511",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-460-0030",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "36775 HIGHWAY 26",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANDY",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97055-7211",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-668-7931",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/19/2007",
    "LastUpdateDate": "05/10/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "2616AT",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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